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Office Visit: Refers to an office setting provision for healthcare provider services.
Open Access (OA): This refers to a self-arrangement plan where enrollees see contracting physicians for medical care. This plan is usually found within the IPA type of health plan.
Open Enrollment Period: Refers to a time where subscribers may re-enroll in a plan or select an alternative health insurance plan without any waiting periods or proof of insurability.
Open Panel: The part of an HMO that allows an enrollee to obtain non-emergency services from a specialist even without a primary care physician's referral.
Organized Delivery Systems: Refers to a network of healthcare providers and insurers that provide medical care and compete with other insurers for regional members. These systems can include physicians and hospitals.
Orthodontia Services: Healthcare services the correct the positions of teeth.
Outcome Measures: Assessments that gauge the results of treatment for a condition or disease. Outcome measures include the enrollee's perceptions of their restoration, their quality of life, and their functionality.
Outcomes: Refers to the results of a healthcare measure and may include a medical procedure or drug treatment.
Outcomes Management: A system that seeks to improve healthcare results my modifying medical care practices in a continuous endeavor to improve outcomes.
Outcomes Research: Refers to studies that measure the effect of a procedure or product on individuals' health or on costs.
Outlier: Refers to a data point, which is outside a statistical range.
Out-Of-Area (OOA): Refers to coverage for healthcare treatment obtained by a covered individual and is temporarily outside the network area.
Out-Of-Network (OON): Refers to the treatment coverage that's obtained by a provider who is not within the network. Usually, this treatment requires a deductible payment or higher co-payments.
Out-Of-Pocket Costs/Expenses (OOPs): Refers to the payment portion for covered healthcare services.
Out-of-pocket maximum (limit): Refers to the annual out-of-pocket maximum cost an insurance provider must pay for an enrollee's healthcare.
Outpatient: Refers to an individual who receives medical care at a free-standing surgical center or clinic.
Outpatient Surgical Center: Refers to the healthcare facility where prescheduled surgical services are performed.
Over-The-Counter (OTC) Drug: Refers to a drug that an individual can obtain without a prescription.
Overall Limits: Term used to refer to benefit plan restrictions.